The proposal is for an epidemiological study of premature death in schizophrenia and major affective disorder. The primary goal is to test previous reports that excess mortality in the major psychoses is attributable to specified diseases and unnatural causes such as suicide. The long-term objective is to identify all potential causes of excess mortality in the major psychoses, in order to reduce or prevent unnecessary premature death in those at risk for disabling psychiatric illness. The type of psychiatric illness, gender, age at admission, and socio-economic status have been reported to affect chances of survival for three to four decades following psychiatric hospital admission. Other hypothesized mortality factors include suicides and accidents, circulatory system diseases in female manics, and infective diseases in male and female schizophrenics. We plan to test the practical and statistical significance of these factors, and also to search for other forms of physical morbidity that reduce survival of schizophrenics and manic-depressives. The search will include neoplasms, respiratory, digestive, and nervous system diseases, genito-urinary diseases, and diseases of the musculoskeletal system. The study population consists of British psychiatric admissions for schizophrenia (expected N=4,000-5,000) and major affective disorder (expected N=3,000-4,000) whose cumulative linked medical records are contained in the Oxford Record Linkage Study (ORLS). The ORLS is a medical information system that contains cumulative individual files of linked medical and vital records for a catchment area of over two million persons in the four countries surrounding Oxford, U.K. Individual files contain linked data from general and psychiatric hospital discharges and death certificates. We will use psychiatric hospital and surgical controls, and regional vital statistics, to test hypotheses of excess mortality and causes of shortened survival in the study population. As part of the search for important causes of death, we will also examine associations of serious physical diseases with schizophrenia and major effective disorder. The results of the analyses should aid in reducing the serious and perhaps unnecessary risk of premature death that is currently associated with major psychotic illness.